CHAPTER 11 Nutrition

Therapeutic Diets High-fiber (high-residue) diet Indications

Used for constipation, irritable bowel syndrome when the primary symptom is alternating constipation and diarrhea, and asymptomatic diverticular disease.

Therapeutic Diets Low-purine diet Indication

Used for gout, kidney stones, and elevated uric acid levels

Therapeutic Diets Renal diet Indications

Used for the client with acute kidney injury or chronic kidney disease and those requiring hemodialysis or peritoneal dialysis

Food Sources of Vitamins Fat-Soluble Vitamins

Vitamin A: Liver, egg yolk, whole milk, green or orange vegetables, fruits Vitamin D: Fortified milk, fish oils, cereals Vitamin E: Vegetable oils; green leafy vegetables; cereals; apricots, apples, and peaches Vitamin K: Green leafy vegetables; cauliflower and cabbage

Nutrition Throughout Growth and Development School-Age

Children in this age group have better appetites with a more varied intake. Assess for adequate intake of protein and vitamins A and C. This age group is at risk for high intake of fats, sugar, and salt related to snack foods. Promote healthy choices and encourage physical activity.

Nutrition Throughout Growth and Development Pregnancy

During pregnancy, protein requirements increase to 60 g per day. Calcium needs increase to promote fetal bone mineralization. Iron supplements support increased blood volume. Folic acid intake is required for DNA synthesis and red blood cell production.

Therapeutic Diets High-calorie, high-protein diet Indications

1. Indication: Used for severe stress, burns, wound healing, cancer, human immunodeficiency virus, acquired immunodeficiency syndrome, chronic obstructive pulmonary disease, respiratory failure, or any other type of debilitating disease.

Therapeutic Diets Lacto-ovo-vegetarian

1. Lacto-ovo-vegetarians follow a food pattern that allows for the consumption of dairy products and eggs. 2. Consumption of adequate plant and animal food sources that excludes meat, poultry, pork, and fish poses no nutritional risks.

Therapeutic Diets Lacto-vegetarian

1. Lacto-vegetarians eat milk, cheese, and dairy foods but avoid meat, fish, poutry, and eggs. 2. A diet of whole or enriched grains, legumes, nuts, seeds, fruits, and vegetables in sufficient quantities to meet energy needs provides a balanced diet.

My Plate Guidelines

1. Avoid eating oversized portions of foods. 2. Fill half of the plate with fruits and vegetables. 3. Vary the type of vegetables and fruits eaten. 4. Select at least half of the grains as whole grains. 5. Ensure that foods from the dairy group are high in calcium. 6. Drink milk that is fat-free or low fat (1%). 7. Eat protein foods that are lean. 8. Select fresh foods over frozen or canned foods. 9. Drink water rather than liquids that contain sugar.

83. A postoperative client has been placed on a clear liquid diet. The nurse should provide the client with which items that are allowed to be consumed on this diet? Select all that apply. 1. Broth 2. Coffee 3. Gelatin 4. Pudding 5. Vegetable juice 6. Pureed vegetables

1. Broth 2. Coffee 3. Gelatin A clear liquid diet consists of foods that are relatively transparent to light and are clear and liquid at room and body temperature. These foods include items such as water, bouillon, clear broth, carbonated beverages, gelatin, hard candy, lemonade, ice pops, and regular or decaffeinated coffee or tea. The incorrect food items are items that are allowed on a full liquid diet.

The nurse instructs a client with chronic kidney disease who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the dietary menu? 1. Cream of wheat, blueberries, coffee 2. Sausage and eggs, banana, orange juice 3. Bacon, cantaloupe melon, tomato juice 4. Cured pork, grits, strawberries, orange juice

1. Cream of wheat, blueberries, coffee Rationale: The diet for a client with chronic kidney disease who is receiving hemodialysis should include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids, which is indicated in the correct option. The food items in the remaining options are high in sodium, phosphorus, or potassium.

Therapeutic Diets Sodium-restricted diet Indications

1. Indication: Used for hypertension, heart failure, renal disease, cardiac disease, and liver disease.

Therapeutic Diets Protein-restrict diet Indications

1. Indication: Used for renal disease and end-stage liver disease. 2. The nutritional status of critically ill clients with protein-losing renal diseases, malabsorption syndromes, and continuous renal replacement therapy or dialysis should have their protein needs assessed by estimating the protein equivalent of nitrogen appearance (PNA); a nutritionist should be consulted.

The nurse is reviewing laboratory results and notes that a client's serum sodium level is 150 mEq/L (150 mmol/L). The nurse reports the serum sodium level to the primary health care provider (PHCP), and the PHCP prescribes dietary instructions based on the sodium level. Which acceptable food items does the nurse instruct the client to consume? Select all that apply. 1. Peas 2. Nuts 3. Cheese 4. Cauliflower 5. Processed oat cereals

1. Peas 2. Nuts 4. Cauliflower Rationale: The normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). A serum sodium level of 150 mEq/L (150 mmol/L) indicates hypernatremia. On the basis of this finding, the nurse would instruct the client to avoid foods high in sodium. Peas, nuts, and cauliflower are good food sources of phosphorus and are not high in sodium (unless they are canned or labeled salted). Peas and cauliflower are also a good source of magnesium. Processed foods such as cheese and processed oat cereals are high in sodium content.

Therapeutic Diets Vegans

1. Vegans follow a strict vegetarian diet and consume no animal foods. 2. Eat only foods of plant origin (e.g., whole or enriched grains, legumes, nuts, seeds, fruits, vegetables). 3. The use of soybeans, soy milk, soybean curd (tofu), and processed soy protein products enhance the nutritional value of the diet.

A client is recovering from abdominal surgery and has a large abdominal wound. The nurse should encourage the client to eat which food item that is naturally high in vitamin C to promote wound healing? 1. Milk 2. Oranges 3. Bananas 4. Chicken

2. Oranges Rationale: Citrus fruits and juices are especially high in vitamin C. Bananas are high in potassium. Meats and dairy products are two food groups that are high in the B vitamins.

88. The nurse provides instructions to a client with a low potassium level about the foods that are high in potassium and tells the client to consume which foods? Select all that apply. 1. Peas 2. Raisins 3. Potatoes 4. Cantaloupe 5. Cauliflower 6. Strawberries

2. Raisins 3. Potatoes 4. Cantaloupe 6. Strawberries Rationale: The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Common food sources of potassium include avocado, bananas, cantaloupe, carrots, fish, mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, and tomatoes. Peas and cauliflower are high in magnesium.

A client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse should offer which full liquid item to the client? 1. Tea 2. Gelatin 3. Custard 4. Ice pop

3. Custard Rationale: Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks, milk, pudding and custard, soups that are strained, refined cooked cereals, and strained vegetable juices. A clear liquid diet consists of foods that are relatively transparent. The food items in the incorrect options are clear liquids.

79. The nurse is planning to teach a client with malabsorption syndrome about the necessity of following a low-fat diet. The nurse develops a list of high-fat foods to avoid and should include which food items on the list? Select all that apply. 1. Oranges 2. Broccoli 3. Margarine 4. Cream cheese 5. Luncheon meats 6. Broiled haddock

3. Margarine 4. Cream cheese 5. Luncheon meats Rationale: Fruits and vegetables tend to be lower in fat because they do not come from animal sources. Broiled haddock is also naturally lower in fat. Margarine, cream cheese, and luncheon meats are high-fat foods.

The nurse is instructing a client with hypertension on the importance of choosing foods low in sodium. The nurse should teach the client to limit intake of which food? 1. Apples 2. Bananas 3. Smoked salami 4. Steamed vegetables

3. Smoked salami Rationale: Smoked foods are high in sodium, which is noted in the correct option. The remaining options are fruits and vegetables, which are low in sodium.

The nurse is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of which food? 1. Milk 2. Chicken 3. Broccoli 4. Legumes

4. Legumes Rationale: The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Legumes are especially rich in this vitamin. Other good food sources include nuts, whole-grain cereals, and pork. Milk contains vitamins A, D, and B2. Poultry contains niacin. Broccoli contains vitamins C, E, and K and folic acid.

The nurse is teaching a client who has iron deficiency anemia about foods she should include in the diet. The nurse determines that the client understands the dietary modifications if which items are selected from the menu? 1. Nuts and milk 2. Coffee and tea 3. Cooked rolled oats and fish 4. Oranges and dark green leafy vegetables

4. Oranges and dark green leafy vegetables Rationale: Dark green leafy vegetables are a good source of iron, and oranges are a good source of vitamin C, which enhances iron absorption. All other options are not food sources that are high in iron and vitamin C.

A client with hypertension has been told to maintain a diet low in sodium. The nurse who is teaching this client about foods that are allowed should include which food item in a list provided to the client? 1. Tomato soup 2. Boiled shrimp 3. Instant oatmeal 4. Summer squash

4. Summer squash

2015-2020 Dietary Guidelines for Americans

A. Provides average daily consumption guidelines for the five food groups (see https://health.gov/dietaryguidelines/2015/guidelines/). B. Guidelines 1. Maintain healthy body weight. 2. Increase physical activity and decrease sedentary activities. 3. Limit saturated fats and trans fats, with less than 10% of daily calories from saturated fats. 4. Limit added sugars so that less than 10% of daily calories are from added sugars. 5. Consume less than 2300 milligrams (mg) of sodium per day. 6. Consume low-sodium and potassium-rich foods. 7. Limit alcohol intake to moderate use (one drink daily for women and two drinks daily for men). 8. Use food-safety principles of Clean, Separate, Co

Gas-Forming Foods

Apples, Artichokes , Barley, Beans, Bran, Broccoli, Brussels sprouts, Cabbage, Celery, Figs, Melons, Milk, Molasses, Nuts, Onions, Radishes, Soybeans, Wheat, Yeast.

Therapeutic Diets High-calcium diet Indication

Calcium is needed during bone growth and in adulthood to prevent osteoporosis and to facilitate vascular contraction, vasodilation, muscle contraction, and nerve transmission.

Food Sources of Minerals Calcium

Cheese Collard greens Milk and soy milk Rhubarb Sardines Tofu Yogurt

Therapeutic Diets Enteral Nutrition Indication

Description: Provides liquefied foods into the gastrointestinal tract via a tube Indications 1. When the gastrointestinal tract is functional but oral intake is not meeting estimated nutrient needs 2. Used for clients with swallowing problems, burns, major trauma, liver or other organ failure, or severe malnutrition

Nutrition Throughout Growth and Development Older Adults

Energy needs are decreased due to slowed metabolic rate. Age-related changes that affect nutrition include changes in teeth and saliva production, reduced taste and smell, decreased thirst sensation, and decreased gag reflex. Ensure adequate calcium and vitamin D intake to prevent osteoporosis.

Nutrition Throughout Growth and Development Young and Middle Adults

Energy needs decrease as the growth period ends. Lack of physical activity and access to certain foods increases the risk of obesity.

Nutrition Throughout Growth and Development Adolescent

Energy needs increase to meet the increased metabolic needs of growth. This age group has increased requirements of daily protein, calcium for bone growth, and iron replace menstrual losses for girls and promote muscle development for boys. Increased intake of iodine and B-complex vitamins are necessary to support thyroid development and metabolism. Fast-food consumption is common and puts the adolescent at risk for at risk malnutrition and obesity. The onset of eating disorders commonly occurs during adolescence.

Food Sources of Vitamins Water-Soluble Vitamins

Folic acid: Green leafy vegetables; liver, beef, and fish; legumes; grapefruit and oranges Niacin: Meats, poultry, fish, beans, peanuts, grains Vitamin B1 (thiamine): Pork and nuts, whole-grain cereals, and legumes Vitamin B2 (riboflavin): Milk, lean meats, fish, grains Vitamin B6 (pyridoxine): Yeast, corn, meat, poultry, fish Vitamin B12 (cobalamin): Meat, liver Vitamin C (ascorbic acid): Citrus fruits, tomatoes, broccoli, cabbage

Therapeutic Diets Potassium-modified diet

Foods that are low in potassium include applesauce, green beans, cabbage, lettuce, peppers, grapes, blueberries, cooked summer squash, cooked turnip greens, pineapple, and raspberries. b. Foods that are high in potassium. Avocado Bananas Cantaloupe Carrots Fish Mushrooms Oranges Pork, beef, veal Potatoes Raisins Spinach Strawberries Tomatoes.

Nutrition Throughout Growth and Development Breastfeeding

For the breastfeeding mother, encourage intake of protein, calcium, and vitamins A, B, and C. Promote adequate fluid intake. Breastfeeding mothers should consume an additional 500 kilocalories per day to support adequate production of breastmilk. Avoid alcohol, caffeine, and drugs, as these are absorbed into breast milk.

Therapeutic Diets Full liquid diet Indications

May be used as a transition diet after clear liquids following surgery or for clients who have difficulty chewing, swallowing, or tolerating solid foods.

Therapeutic Diets Celiac disease

Treatment for celiac disease and gluten sensitivity for clients needing the protein fraction "gluten" eliminated from their diet.

MyPlate

It provides a description of a balanced diet that includes grains, vegetables, fruits, dairy products, and protein foods. (http://www.choosemyplate.gov/).

Nutrition Throughout Growth and Development Toddlers and Preschoolers

Milk is a poor source of iron, and children who consume more than 24 ounces of milk per day are at risk for developing milk anemia. Whole milk should be consumed until 2 years of age to ensure adequate fatty acid intake. Limit foods that pose choking hazards, such as hot dogs, candy, nuts, grapes, popcorn, and raw vegetables.

Therapeutic Diets Enteral Nutrition

Nursing considerations 1. Clients with lactose intolerance need to be placed on lactose-free formulas. 2. See Chapter 69 for information regarding the administration of gastrointestinal tube feedings and associated complications.

Therapeutic Diets High-iron diet Indication

Used for clients with anemia

Therapeutic Diets Carbohydrate-consistent diet Indications

Used for clients with diabetes mellitus, hypoglycemia, hyperglycemia, and obesity.

Nutrition Throughout Growth and Development Infant

The American Academy of Pediatrics recommends breastfeeding for the first 6 months of life and breastfeeding with additional foods from age 6 to 12 months. Introduce new foods one at a time, 4-7 days apart, to identify allergies. Infants should not have cow's milk before the age of 1 year. Children under 1 year of age should not ingest honey or corn syrup products dues to the risk of botulism toxin.

Therapeutic Diets Ovo-vegetarians

The only animal foods that the ovo-vegetarian consumes are eggs, which are an excellent source of complete proteins.

Therapeutic Diets Clear liquid diet Nursing Consideration

a. Clear liquid diet is deficient in energy (calories) and many nutrients. b. Clear liquid diet is easily digested and absorbed. c. Minimal residue is left in the gastrointestinal tract. d. Clients may find a clear liquid diet unappetizing and boring. e. As a transition diet, clear liquids are intended for short-term use. f. Clear liquids and foods that are relatively transparent to light and are liquid at body temperature are considered "clear liquids," such as water, bouillon, clear broth, carbonated beverages, gelatin, hard candy, lemonade, ice pops, and regular or decaffeinated coffee or tea. g. By limiting caffeine intake, an upset stomach and sleeplessness may be prevented. h. The client may consume salt and sugar. i. Dairy products and fruit juices with are not clear liquids. j. Instruct the client doing bowel to avoid liquids that contain red or purple dye, which can mask the normal color of the lining of the colon.

Therapeutic Diets Renal diet Nursing consideration

a. Controlled amounts of protein, sodium, phosphorus, calcium, potassium, and fluids may be prescribed; may also need modification in fiber, cholesterol, and fat based on individual requirements; clients on peritoneal dialysis usually have diets prescribed that are less restrictive with fluid and protein intake than those on hemodialysis. b. Most clients receiving dialysis need to restrict fluids. c. Monitor weight daily as a priority, because weight is an important indicator of fluid status.

Therapeutic Diets High-calorie, high-protein diet Nursing consideration

a. Encourage nutrient-dense, high-calorie, high-protein foods such as whole milk and milk products, peanut butter, nuts and seeds, beef, chicken, fish, pork, and eggs. b. Encourage snacks between meals, such as milkshakes, instant breakfasts, and nutritional supplements. Calorie counts assist in determining the client's total nutritional intake and can identify a deficit or excess intake.

Therapeutic Diets Soft diet Nursing Considerations

a. Foods include easily digestible foods such as pastas, casseroles, tender meats, canned fruit, cooked vegetables, cakes, and cookies without nuts or coconut. b. Clients with mouth sores should be served foods at cooler temperatures. c. Clients who have difficulty chewing and swallowing because of dry mouth can increase salivary flow by sucking on sour candy. d. Encourage the client to eat a variety of foods. e. Provide plenty of fluids with meals to ease chewing and swallowing of foods. f. Drinking fluids through a straw may be easier than drinking from a cup or glass; a straw may not be allowed for clients with dysphagia (because of the risk of aspiration). g. All foods and seasonings are permitted; however, liquid, chopped, or pureed foods or regular foods with a soft consistency are tolerated best. h. Foods that contain nuts or seeds, which easily can become trapped in the mouth and cause discomfort, should be avoided. i. Raw fruits and vegetables, fried foods, and whole grains should be avoided.

Therapeutic Diets Low-fiber (low-residue) diet Nursing considerations

a. Foods that are low in fiber include white bread, refined cooked cereals, cooked potatoes without skins, white rice, and refined pasta. b. Foods to limit or avoid are raw fruits (except bananas), vegetables, nuts and seeds, plant fiber, and whole grains. c. Dairy products should be limited to 2 servings a day.

Therapeutic Diets High-fiber (high-residue) diet Nursing considerations

a. High-fiber diet provides 20 to 35 g of dietary fiber daily. b. Volume and weight are added to the stool, speeding the movement of undigested materials through the intestine. c. High-fiber foods are fruits and vegetables and whole-grain products. d. Increase fiber gradually and provide adequate fluids to reduce possible undesirable side effects such as abdominal cramps, bloating, diarrhea, and dehydration. e. Gas-forming foods should be limited

Therapeutic Diets Cardiac diet Indications

a. Indicated for atherosclerosis, diabetes mellitus, hyperlipidemia, hypertension, myocardial infarction, nephrotic syndrome, and renal failure. b. Reduces the risk of heart disease. c. Dietary Approaches to Stop Hypertension (DASH) diet: recommended to prevent and control hypertension, hypercholesterolemia, and obesity. d. The DASH diet includes fruits, vegetables, whole grains, low-fat dairy foods, meat, fish, poultry, nuts, and beans; it is limited in sugar-sweetened foods and beverages, red meat, and added fats.

Therapeutic Diets Sodium-restricted diet Nursing consideration

a. Individualized; can include 4 g of sodium daily (no-added-salt diet), 2 to 3 g of sodium daily (moderate restriction), 1 g of sodium daily (strict restriction), or 500 mg of sodium daily (severe restriction and seldom prescribed). b. Encourage intake of fresh foods, rather than processed foods that contain higher amounts of sodium. c. Canned, frozen, instant, smoked, pickled, and boxed foods usually contain higher amounts of sodium. Lunch meats, soy sauce, salad dressings, fast foods, soups, and snacks such as potato chips and pretzels also contain large amounts of sodium; teach clients to read nutritional facts on product packaging regarding sodium content per serving. d. Certain medications contain significant amounts of sodium. e. Salt substitutes may be used to improve palatability; most salt substitutes contain large amounts of potassium and should not be used by clients with renal disease.

Therapeutic Diets Potassium-modified diet Indications

a. Low-potassium diet is indicated for hyperkalemia, which may be caused by impaired renal function, hypoaldosteronism, Addison's disease, angiotensin-converting enzyme inhibitor medications, immunosuppressive medications, potassium-retaining diuretics, and chronic hyperkalemia. b. High-potassium diet is indicated for hypokalemia, which may be caused by renal tubular acidosis, gastrointestinal losses (diarrhea, vomiting), intracellular shifts, potassium-losing diuretics, antibiotics, mineralocorticoid or glucocorticoid excess resulting from primary or secondary aldosteronism, Cushing's syndrome, or exogenous corticosteroid use.

Therapeutic Diets Full liquid diet Nursing Consideration

a. May be used as a transition diet after clear liquids following surgery or for clients who have difficulty chewing, swallowing, or tolerating solid foods. b. The diet includes clear and opaque liquid foods and those that are liquid at body temperature. c. Foods include all clear liquids and items such as plain ice cream, sherbet, breakfast drinks, milk, pudding and custard, soups that are strained, refined cooked cereals, fruit juices, and strained vegetable juices. d. Use of a complete nutritional liquid supplement is often necessary to meet nutrient needs for clients on a full liquid diet for more than 3 days. Provide nutritional supplements such as those high in protein, as prescribed, for the client on a liquid diet.

Therapeutic Diets High-calcium diet Nursing consideration

a. Primary dietary sources of calcium are dairy products. b. Lactose-intolerant clients should incorporate non-dairy sources of calcium into their diet regularly.

Therapeutic Diets Protein-restrict diet Nursing consideration

a. Provide enough protein to maintain nutritional status but not an amount that will allow the buildup of waste products from protein metabolism (40 to 60 g of protein daily). b. The less protein allowed, the more important it becomes that all protein in the diet be of high biological value (contain all essential amino acids in recommended proportions). c. An adequate total energy intake from foods is critical for clients on protein- restricted diets (protein will be used for energy rather than for protein synthesis). d. Special low-protein products, such as pastas, bread, cookies, wafers, and gelatin made with wheat starch, can improve energy intake and add variety to the diet. e. Carbohydrates in powdered or liquid forms can provide additional energy. f. Vegetables and fruits contain some protein and, for very-low-protein diets, these foods must be calculated into the diet. g. Foods are limited from the milk, meat, bread, and starch groups.

Therapeutic Diets Clear liquid diet Indications

a. Provides fluids and some electrolytes to prevent dehydration. b. Used as an initial feeding after complete bowel rest. c. Used initially to feed a malnourished person or a person who has not had any oral intake for some time. d. Used for bowel preparation for surgery or diagnostic tests, as well as postoperatively and in clients with fever, vomiting, or diarrhea. e. Used in gastroenteritis.

Therapeutic Diets Mechanical soft diet Indications

a. Provides foods that have been mechanically altered in texture to require minimal chewing. b. Used for clients who have difficulty chewing but can tolerate more variety in texture than a liquid diet offers. c. Used for clients who have dental problems, surgery of the head or neck, or dysphagia (requires swallowing evaluation and may require thickened liquids if the client has swallowing difficulties).

Therapeutic Diets Low-purine diet Nurse consideration

a. Purine is a precursor for uric acid, which forms stones and crystals. b. Foods to restrict include anchovies, herring, mackerel mackerel, sardines, scallops, organ meats, gravies, meat extracts, wild game, goose, and sweetbreads.

Therapeutic Diets Fat-restrict diet Nursing consideration

a. Restrict total amount of fat, including saturated, trans, polyunsaturated, and monounsaturated. b. Clients with malabsorption may also have difficulty tolerating fiber and lactose. c. Vitamin and mineral deficiencies may occur in clients with diarrhea or steatorrhea. d. A fecal fat test may be prescribed and indicates fat malabsorption with excretion of more than 6 to 8 g of fat (or more than 10% of fat consumed) per day during the 3 days of specimen collection.

Therapeutic Diets Cardiac diet Nursing Consideration

a. Restrict total amounts of fat, including saturated, trans, polyunsaturated, and monounsaturated; cholesterol; and sodium. b. Teach the client about the DASH diet or other prescribed diet.

Therapeutic Diets Low-fiber (low-residue) diet Indications

a. Supplies foods that are least likely to form an obstruction when the intestinal tract is narrowed by inflammation or scarring or when gastrointestinal motility is slowed. b. Used for inflammatory bowel disease, partial obstructions of the intestinal tract, gastroenteritis, diarrhea, or other gastrointestinal disorders.

Therapeutic Diets Carbohydrate-consistent diet Nursing considerations

a. The Exchange System for Meal Planning, developed by the Academy of Nutrition and Dietetics and the American Diabetes Association, is a food guide that may be recommended. b. The Exchange System, groups foods according to the amounts of carbohydrates, fats, and proteins they contain; major food groups include the carbohydrate, meat and meat substitute, and fat groups. c. A carbohydrate-consistent diet focuses on maintaining a consistent amount of carbohydrate intake each day and with each meal; also known as "carb counting." d. The MyPlate diet may also be recommended.

Therapeutic Diets Mechanical soft diet Nursing considerations

a. The degree of texture modification depends on individual need, including pureed, mashed, ground, or chopped. b. Foods include those that are part of a clear and full liquid diet, with the addition of all cream soups, ground or diced meats, flaked fish, cottage cheese, rice, potatoes, pancakes, light breads, cooked vegetables, canned or cooked fruits, bananas, peanut butter, and non-fried eggs. c. Foods to be avoided in mechanically altered diets include nuts; dried fruits; raw fruits and vegetables; fried foods; tough, smoked, or salted meats; and foods with coarse textures.

Therapeutic Diets High-iron diet Nursing consideration

a. The high-iron diet replaces iron deficit b. The diet includes organ meats, meat, egg yolks, whole-wheat products, dark green leafy vegetables, dried fruit, and legumes. c. Inform the client that concurrent intake of vitamin C with iron foods enhances absorption of iron.

Therapeutic Diets Soft diet Indications

a. Used for clients who have difficulty chewing or swallowing. b. Used for clients who have ulcerations of the mouth or gums, oral surgery, broken jaw, plastic surgery of the head or neck, or dysphagia, or for the client who has had a stroke.

Therapeutic Diets Fat-restrict diet Indications

a. Used to reduce symptoms of abdominal pain, steatorrhea, flatulence, and diarrhea associated with high intakes of dietary fat and to decrease nutrient losses caused by ingestion of dietary fat in individuals with malabsorption disorders. b. Used for clients with malabsorption disorders, pancreatitis, gallbladder disease, and gastroesophageal reflux.

Measures to Relieve Thirst

▪ Chew gum or suck hard candy. ▪ Freeze fluids so they take longer to consume. ▪ Add lemon juice to water to make it more refreshing. ▪ Gargle with refrigerated mouthwash.